I’m currently a nurse but am interested in coding as this increases my opportunity to work remotely. I’m curious what you would recommend to start with my background? I am looking at doing the AAPC instructor led training course. Thoughts?

Hi - my son recently had an EKG and they're saying we owe $1700. We've had semi-regular EKGs since 2017 (every 2-3 years) and I don't remember the charge ever being so large before. I'm posting here at the suggestion of someone in an old thread on r/personalfinance -- in that thread the consensus seems to be that if a certain code is present (93303) then that includes many of the other services that should not be billed separately. Here's what we were billed -- I'd appreciate any thoughts on what I could/should say to the billing department at the hospital. We live in Ohio if it matters on the Medical Mutual HMO network.

Bill #1, Physician - total bill $513, our balance is $270 after insurance

Complete Tthrc Echo Congenital Cardiac Anomaly - 93303 (CPT®) $173.00

Doppler Echocard Pulse Wave W/Spectral Display - 93320 (CPT®) $52.00

Dop Echocard Color Flow Velocity Mapping - 93325 (CPT®) $54.00

Ecg Routine Ecg W/Least 12 Lds I&R Only - 93010 (CPT®) $23.00

Office/Outpatient Established Mod Mdm 30 Min - 99214 (CPT®) $188.00

Ecg Routine Ecg W/Least 12 Lds I&R Only - 93010 (CPT®) $23.00

Bill #2, Hospital Services - total bill $4353, we owe $1413 after insurance

Transthoracic Echocardiography - 93303 (CPT®) $1,818.00

HC Doppler Echo Exam Heart - Transesophageal Echo (Tee) Complete - 93320 (CPT®) $881.00

Doppler Color Flow add-on - 93325 (CPT®) $722.00

Office Visit Level 4 Established Patient - 99214 (CPT®) $180.00

Electrocardiogram Routine Ecg W/ At Least 12 Leads Tracing Only - 93005 (CPT®) $376.00

Electrocardiogram Routine Ecg W/ At Least 12 Leads Tracing Only - 93005 (CPT®) $376.00

(that last one appears twice on our bill)

I need some study suggestions for CPC maybe Quizlet links or anything that’d be perfect to study before exam so I can be confident. I’m all out of practice test and didn’t take any notes while doing them due to the timer. I live on my school campus but our WiFi speed is so bad that the proctor wouldn’t let me start the test so she canceled I was charged a fee for that almost had to pay full price. I also wasted my second try after calling and booking a private room in the library they lied and said I could use their exam rooms when I got there they claimed no one’s allowed up and placed me in a clear glass booth and obviously it was too late to reschedule and proctor canceled so I also lost my second exam try. It’s been a very hard time when I went to get my laptop from my moms it was broken like physically damaged and I just finished fixing it. Decided on just getting a hotel room to do my test and call it a day would appreciate any advice on what study material is good I know I struggle with the first few anatomy questions on the practice tests.

I live in MN and bcbs denied me my prior authorization for surgery so I appealed it with the state and was approved. I just received a letter saying they approved for my services but that it was not an approval for claim payment. Does that mean after my surgery they are going to pull the rug from underneath me and screw me by not paying?

I work as a medical lab scientist and as much as I love my career, this does not offer remote work at all. I’m looking to transition into medical coding for the potential of remote work. Since I have almost 12 years in a hospital setting and background, I’m hoping to have a decent transition and training for this certification. Has anyone else made this transition from another hospital career? Can I get certified in a shorter time frame with my background? Any advice is appreciated!

Hi all, I just started this course. I was hoping someone experienced with it could give me some insight into pacing. It is broken into seven steps, but I can only access each once I've completed the previous one. I don't know how much time I should spend in each area. I feel like I have to rush because I don't know what's left, and I would like to be more thorough.

TIA!

I'm curious how much people are making coding now, in 2024. What do you think is a fair pay range for coding? I've searched here but the most recent posts regarding pay that I I'm finding are several years old.

I'm currently 2 years into my billing/coding career and thoroughly enjoying the field. I hold a certificate through the NHA and while I'm grateful it got my foot in the door, I need some advice concerning future certificates and a 4 year plan. I'm looking into an accreditation through the AAPC. What would be the best basic certification, initially? And following that certification, the most lucrative/reliable specialties? I'm open to options outside of the AAPC.

I’m a provider in a solo practice and I’m incredibly confused about third party administrators (TPAs). I’ve had several patients who come in with insurance through a TPA and then when I try to submit the claim with the insurance company my billing people (I have Athenahealth do my billing stuff) keep telling me that I need to be credentialed with the TPA. That doesn’t seem right to me because the TPA isn’t insurance, it’s just the third party communication with the insurance companies which I am credentialed with. Plus, it is my understanding that some TPAs require a quicker claim submission than the insurance companies require, often making it impossible to “credential” with them before that time period lapses.

I feel like I’m missing something vital here… any help would be great appreciated.

Background info: I own my own practice and don’t have any admin staff, so I can’t task someone else with this. I do all of the communicating with insurance companies.

I took a test on the surgery-endocrinology section of CPT book. I'm so confused by why some of the scenarios required a laterality modifier and others do not. Can someone please help me understand this?

All of the scenarios specified laterality, but I was marked wrong for including it. Here are some examples with the correct answers:

NO MODIFIER:

After a cervical incision was made, the muscles of the neck were separated to expose the thyroid and parathyroid glands. The right lobe was normal in appearance and size. The left upper thyroid gland had a goiter measuring approximately 3.0 cm. This lobe with the goiter was removed. Correct answer: 60220 

After adequate general anesthesia, a cervical incision was made to expose the thyroid and parathyroid glands. The parathyroid glands were directly visualized. The right parathyroid gland was removed. Correct answer: 60500 

MODIFIER

Under general anesthesia, a cervical incision at the previous incision site was done. The neck muscles were divided and retracted. The thyroid area was exposed. The absent left lobe of the thyroid was noted. Theright lobe of the thyroid was examined. It was found to be very nodular in appearance. This lobe was removed as part of a secondary thyroidectomy, which involved removing all remaining thyroid tissue following previous removal of the left lobe. The parathyroid glands were examined and appeared normal. The specimen of the right lobe was sent to pathology. The muscles were retracted back and closed with staples. The incision was closed in layers. Correct answer: 60260-RT

After the patient's adrenal area was accessed through a midline abdominal incision, the retroperitoneal space was explored. A mass was identified adjacent to the left adrenal gland. This was removed along with the left adrenal gland in toto, which also appeared abnormal. The incision was closed. Correct answer: 60545-LT

Hello all. I am looking to pursue this field of coding and billing. Can anyone give advice on schools/programs to consider and how to gain employment in this area? Is it possible to work in this field part-time? Any advice and/or direction is appreciated. TIA.

I heard their practice exams are obviously the closest to the real test, and it would definitely save me a good chunk of change but are there any other advantages to getting the membership now?

I’m a physician but enjoy learning about coding and reimbursement and optimizing documentation within my group (EM). Curious as to what jobs or pathways you all have seen revolving around this? I know about utilization management, but curious of any others or thoughts in general from the coding and billing professionals!

Help! I am wondering if I am now responsible for covering the diffrence in what my insurance company paid for PT services versus what they charged? Below is the EOB I recieved for PT services for an in-network provider. And then below that is the verage to the finacial agreement I signed- I assumed that all I would owe is a co-pay, and wasn't notified that multiple services they billed for every week wern't covered until I got my EOB this week (after already having 4 appointments. (Ugh). Thanks for any help you can give!!

Amount billed: $445

Your Plan Discount: $39

Your Plan Paid: 30

You Owe: $30

Notes:

A2 The plan discount shown is your savings for using a network provider. The amount you owe may include your copay, coinsurance, deductible, plus any amount due if you''ve reached your benefit limit on a covered service.

PW This service is considered to be included in another service performed on the same claim or date of service. Separately billed services/tests have been bundled and separate payment is not allowed.

Verbage of financial agreement of PT office
Insurance Filing Under Federal regulations, questions concerning eligibility for benefits or coverage of medical treatment or supplies are not claims, and any information provided to you is as a convenience only. It is not a guarantee or determination of benefits and may not be appealed. Benefits will be determined after treatment when a claim is filed in accordance with the plan’s procedures.

****I understand Advanced Training and Rehab cannot guarantee how insurance will process my claims, including, but not limited to, copay’s, deductible’s, and number of visits my insurance covers.**** __________(please initial)

If the payer's rate is less than Advanced Training and Rehab's contracted rate with your insurance carrier, you will be responsible for the difference. If insurance payment is not received within 90 days, the balance will automatically be transferred to patient responsibility; at that time, cash or checks will be accepted. If necessary, a payment plan may be established.

Non-Covered Services Each insurance policy may contain clauses that it does not cover a particular service. This does not mean it is not a medically appropriate service, it simply means that this policy does not cover that service. Additionally, some insurance companies do not deem some treatments/visits as medically necessary even though a doctor has prescribed it. These services are the responsibility of the patient.

Wife went to ER and got double charged for an ultrasound. 1 on the belly (which they never did) and then another one vaginally.

Wife rightfully tried to contest the one they never did but the billing department said the dr put it in their files so they can charge for it... What would you do?

If there's a better place to post this just lmk!

I’m starting classes at my local community college soon- curious, what does your average day look like? Working from home? In a medical office? How do you manage distractions? Are you satisfied with the pace of your job? Thank you in advance!

We have been locked out of our Availity account for many weeks. Availity says it's a known problem, that "randomly locks" accounts and they don't have a solution. (this isn't about resetting passwords - that won't work with us because our account is locked). Customer Service has no other ideas on how to help us get into our account. It's crazy. We escalated and have not received a call back.

Has anyone had their account locked? Any luck with Customer Service? Any other method of contacting them to escalate the issue?

We need to use Availity, it's what BCBSIL requires to interface with them regarding paneling/NPI management/etc. Unless someone else has found another way?

Hi!

I was hoping to ask for a dumbed down explanation on something. I know that 99284 is set based in the ER setting, but I still get confused on what the actual 99222-AI is that if on the same day of the 99284. Is it still within the ER room? Or is the majority of the time for this after/outside of the ER setting?

I bill it often but trying to form words to explain what EXACTLY is done during the 99222 still trips me up.

Thanks a bunch!!

I am a medical biller working with multiple Registered Dietitians. We have been billing CPT code 95249 (Personal Use Continuous Glucose Monitoring) and have encountered denials from BCBS with the reason: “Payment is denied when performed/billed by this type of provider.” However, I have seen a claim for the same code paid by BCBS for another patient.

Could this discrepancy be due to differences in the patient’s plan, or does BCBS generally not cover this code when billed by Registered Dietitians?

The claims are billed to the local and they are denied as not covered by this payer. Then when we call the plan they are stating the dx listed is xx.xx. Has anyone came across this scenario? The plan reps refuse to escalate. I would like to avoid sending paper claims.

Please forgive me if I am posting in the wrong forum but I am questioning what my insurance is saying because it doesn't make sense to me. The short version is my insurance is denying a lipid panel, with the reason being I have "exceeded my benefits". I verified that there is not a plan maximum on diagnostic lab and the claim was to be sent for reprocessing. Now the insurance is saying one of the diagnosis codes submitted, R73.03 (pre-diabetes) is the issue because it's a preventive diagnosis and there is a plan max for "screening" lab. E78.5 (hyperlipidemia) was also submitted on the claim so I'm confused as to why they are using the pre-diabetes code as a reason for denial, when there is a valid medical diagnosis for checking my cholesterol. I have done numerous searches and cannot find anything that states pre-diabetes is considered preventive. I spoke with a supervisor who states they base their guidelines on AMA and CMS who both states it is indeed preventive. I looked at a link she provided for CMS and still can't find anything stating this. Any insight would be appreciated.

Is the Medicare fee schedule for 2025 available online yet? I tried searching on the CMS website, but cannot locate it. I also have this page bookmarked https://www.cms.gov/medicare/physician-fee-schedule/search?Y=0&T=1&HT=0&H1=17311&M=5 - but it does not give me the option to select 2025. I tried googling, no luck. Am i missing something?

I don't know if this is the right place to ask but we have been having so many issues with UMR since our practice opened mid last year. The biggest issue we're having is that for the first 9 months, our main PA-C provider's taxonomy code incorrectly listed her as an RN for all of the UMR claims. So all of the exam procedure codes were processed as a non-reimbursable service. I am having a terrible time getting to reps that understand the issue we're having. The reps that do get them reprocessed seamlessly but the ones that don't it's like I'm speaking another language. We've tried submitting corrected claims and appeals but until someone manually reprocesses it, they don't seem to get fixed.

I guess I am hoping someone has a better way to explain my issue when I'm calling in or messaging on the portal so that I don't get so many that don't understand??

ETA: the procedures like sutures/xray/FB were paid, but exams 99203 and 99213 mostly were not because UMR had her listed as an RN

Just wanted to share that I passed my CPC exam today! I failed it the first time and well second times the charm. I feel so relieved! To any of you still struggling please don’t give up!

hi, i’ve been self studying the last month or so but i’m wondering if the amci mcdc independent study is worth it? especially with the discount, idk how often they do that.

ive heard good and bad things about it but it seems to come with a lot of bonuses.

for reference, i am going off of coding with bleu “syllabus” and starting with anatomy and physiology.

Hi everyone! I’m taking my CPC certification exam in January and will be graduating at the end of December with an associate’s degree and a certificate in medical records.

I have 6 years of experience in finance, 4 of which I worked as a senior team lead. In 2021, I transitioned to healthcare, starting as an outbound agent assisting diabetes patients with ordering supplies. I did that for 2 years before moving to another state, where I worked as a patient scheduler/advocate for a large health system in Louisiana for 2 more years. After another move, I joined Express Scripts, but unfortunately, my team was downsized, leaving me without a job. I then started working part-time with another company while attending school full-time. Currently, I work in a patient services department, handling daily calls for patients who need appointments or assistance with their care.

I’ve been working remotely since 2021 and have gained experience with insurance, but I’m worried my past job experience won’t translate well to billing and coding roles once I (hopefully) pass the CPC exam. I’ve been applying for non-phone or related roles for a year now but keep getting rejected, which is what pushed me to pursue further education. I’m incredibly unhappy in my current job and feel stuck despite constantly applying for something better.

Does my background make me a strong candidate for billing and coding roles? Any tips or advice on breaking into the field would be greatly appreciated!

What do people find the easiest? Most difficult? Least stressful? Most stressful? Most job availabilities?

Hello, I have my CPC-A now and am starting to apply places. Any advice for the interview process? How to make a good impression without experience. Are there things coders look for when hiring? Did anything help you stand out? Anything you did “wrong” in your first interviews you would do differently now?

Hi everyone,

I wanted to share this NPI Search and Download tool to get feedback and see if you find it useful for your use cases of pulling NPI related information.

Currently, this data can be found on the NPPES NPI Registry website, but it is a bit cumbersome if you want to download the results.

This tool allows you to search for NPIs based upon (multiple) NPI numbers, as well as other search criteria such as city, state, taxonomy, etc.

I’d love to hear:

1. How do you currently use NPI data in your workflow or projects?

2. How much NPI data do you typically work with or need at one time?

3. Are there any features you’d like to see added to a tool like this?

Any feedback is greatly appreciated! Thanks!